Transvesical Percutaneous Access Allows for Epidural Anesthesia Without Mechanical Ventilation in Single-Port Robotic Radical and Simple Prostatectomy

Abstract

Objectives: To determine the feasibility of epidural anesthesia in patients undergoing transvesical single-port (SP) robotic simple and radical prostatectomy.

Methods: Patients undergoing transvesical SP robotic radical or simple prostatectomy were selected. Exclusions were underlying obstructive sleep apnea, pulmonary disease, prior lumbar spinal surgery, or BMI >35. Low thoracic or high lumbar epidural catheters were placed in the preoperative unit prior to operating room transport. Demographic information, intraoperative variables, and perioperative outcomes were collected in an IRB-approved database. A descriptive statistical analysis was performed.

Results: A total of 12 patients underwent epidural placement prior to transvesical SP radical (N = 7) and simple (N = 5) prostatectomy. All cases were completed without extra ports, open conversion, or conversion to general anesthesia. No surgical interruptions were noted in 9 of 12 cases and all movement-related interruptions were brief and transient. No anesthetic complications were noted. The one postoperative complication noted was unrelated to anesthesia. Intraoperative opioids were avoided in 5 patients. No patients required opioid medications after discharge and all patients with outpatient encounters were same-day discharges. One patient was a pre-planned admission. Limitations include small number of patients and a single surgeon experience.

Conclusion: Epidural anesthesia without mechanical ventilation is a safe and feasible technique in selected patients undergoing transvesical SP robotic radical and simple prostatectomy. This approach was not associated with any anesthesia-related complications or compromise in perioperative outcomes.